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Why kids and teens may face far more anxiety these days

Second graders play on an iPad in San Antonio, Texas, Feb. 27, 2017. (Ilana Panich-Linsman/Copyright 2018 The New York Times)

When it comes to treating anxiety in children and teens, Instagram, Twitter and Facebook are the bane of therapists' work.

"With (social media), it's all about the self-image - who's 'liking' them, who's watching them, who clicked on their picture," said Marco Grados, associate professor of psychiatry and clinical director of child and adolescent psychiatry at Johns Hopkins Hospital. "Everything can turn into something negative. . . . [K]ids are exposed to that day after day, and it's not good for them."

Anxiety, not depression, is the leading mental health issue among American youths, and clinicians and research both suggest it is rising. The latest study was published in April in the Journal of Developmental and Behavioral Pediatrics. Based on data collected from the National Survey of Children's Health for ages 6 to 17, researchers found a 20 percent increase in diagnoses of anxiety between 2007 and 2012. (The rate of depression over that same time period ticked up 0.2 percent.)

Philip Kendall, director of the Child and Adolescent Anxiety Disorders Clinic at Temple University and a practicing psychologist, was not surprised by the results and applauded the study for its "big picture" approach.

"There is definitely a rise in the identification of kids with serious anxiety," he said. They are "growing up in an environment of volatility, where schools have lockdowns, where there are wars across borders. We used to have high confidence in our environment - now we have an environment that anticipates catastrophe."

The data on anxiety among 18- and 19-year-olds is even starker. Since 1985, the Higher Education Research Institute at UCLA has been asking incoming college freshmen if they "felt overwhelmed" by all they had to do. The first year, 18 percent replied yes. By 2000, that climbed to 28 percent. By 2016, to nearly 41 percent.

The same pattern is clear when comparing modern-day teens to those of their grandparents' or great-grandparents' era. One of the oldest surveys in assessing personality traits and psychopathology is the Minnesota Multiphasic Personality Inventory, which dates to the Great Depression and remains in use today. When Jean Twenge, a professor of psychology at San Diego State University, looked at the MMPI responses from more than 77,500 high school and college students over the decades, she found that five times as many students in 2007 "surpassed thresholds" in more than one mental health category than they did in 1938. Anxiety and depression were six times more common.

Statistics on anxiety in children and younger adolescents aren't easy to come by. The study published last month was based on the National Survey of Children's Health, which the researchers noted "is the only national data source to evaluate the presence of anxiety and depression on a regular basis." The findings were limited, though, and relied on the reports of parents and guardians as to whether a health-care professional had ever told them their child was suffering from one of those conditions.

Those responding yes were asked to describe the level of both anxiety and depression in their children: 10.7 percent said their child's depression was severe, and 15.2 percent who listed their child's anxiety at that level.

Among the study's other findings: Anxiety and depression were more commonly found among white and non-Hispanic children, and children with anxiety or depression were more likely than their peers to be obese. The researchers acknowledge that the survey method - parents reporting what they were told by their child's doctor - likely skewed the results.

Grados often identifies anxiety in the children and adolescents he sees as part of his clinical practice in Baltimore. "I have a wide range [of patients], take all insurances, do inpatients, day hospital, outpatients, and see anxiety across all strata," he said.

The causes of that anxiety also include classroom pressures, according to Grados. "Now we're measuring everything," he said. "School is putting so much pressure on them with the competitiveness . . . I've seen eighth graders admitted as inpatients, saying they have to choose a career!"

Yet even one of the latest study's authors acknowledges that it can be difficult to tease out the truth about the rise in anxiety.

"If you look at past studies," said John T. Walkup, chairman of the Department of Psychiatry at Lurie Children's Hospital in Chicago, "you don't know if the conditions themselves are increasing or clinicians are making the diagnosis more frequently due to advocacy or public health efforts."

Nearly a third of all adolescents ages 13 to 18 will experience an anxiety disorder during their lifetime, according to the National Institutes of Health, with the incidence among girls (38.0 percent) far outpacing that among boys (26.1 percent).

Identifying anxiety in kids and getting them help is paramount, according to clinicians. "Anxiety can be an early stage of other conditions," Grados said. "Bipolar, schizophrenia later in life can initially manifest as anxiety."

For all these reasons, Kendall said, increased awareness is welcome.

"If you look at the history of child mental health problems," he said, "we knew about delinquency at the beginning of the 20th century, autism was diagnosed in the 1940s, teenage depression in the mid-'80s. Anxiety is really coming late to the game."

Story by Amy Ellis Nutt. Nutt covers neuroscience and mental health for The Washington Post. She won the Pulitzer Prize in feature writing in 2011 and previously worked at the Star-Ledger in Newark, NJ and Sports Illustrated.